Reporting Digital Breast Tomosynthesis Mammography in 2015

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  • March 30, 2015
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Reporting Digital Breast Tomosynthesis Mammography in 2015

The CPT® Editorial Panel created three new codes (77061, 77062, and 77063) for 2015 to describe the physician work and practice expense associated with screening and diagnostic digital breast tomosynthesis (DBT). In the 2015 Medicare Physician Fee Schedule (MPFS) Final Rule, however, the Centers for Medicare & Medicaid Services (CMS) established a payment rate for just one of those codes: 77063 Screening digital breast tomosynthesis, bilateral.
CPT® 77063 is an add-on code and, as CMS instructs in MLN Matters® article MM8874-Revised, this service should be reported only when it is furnished in with 2D digital mammography. CMS created HCPCS Level II code G0202 Screening mammography, producing direct digital image, bilateral, all views, 2D imaging only for this purpose. Effective Jan. 1, 2015, 77063 must be reported with G0202.
Payment for 77063 will be made only when medically necessary and reported with ICD-9 code V76.11 Screening mammogram for high-risk patient or V76.12 Other screening mammogram (or when ICD-10 is effective, Z12.31 Encounter for screening mammogram for malignant neoplasm of breast).
In lieu of using the new diagnostic DBT codes 77061 Digital breast tomosynthesis; unilateral and 77062 Digital breast tomosynthesis; bilateral, CMS created add-on code G0279 Diagnostic digital breast tomosynthesis, unilateral or bilateral, to be used with the existing digital diagnostic mammography HCPCS Level II codes G0204 Diagnostic mammography, producing direct 2D digital image, bilateral, all views and G0206 Diagnostic mammography, producing direct 2D digital image, unilateral, all views.
According to the American College of Radiology (ACR®), this leaves “no means to report diagnostic DBT when it is reported separately from a full-field digital mammogram (FFDM).”
Patients are not responsible for any co-pays or deductibles associated with the new screening DBT codes, including add-on code 77063. Code G0279 relates to a diagnostic procedure; therefore, it does not follow the same policies as those established for the screening studies.
Remember: Append modifier GG Performance and payment of a screening mammography and diagnostic mammography on the same patient, same day to show the test changed from a screening test to a diagnostic test. Payers will pay for both tests.
CMS notes in the MPFS Final Rule that they will continue to pay for mammography services at the 2014 rates until they revalue all mammography services, ACR reports.

Renee Dustman
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Renee Dustman, BS, AAPC MACRA Proficient, is an executive editor at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 20 years experience in print production and content management. Follow her on Twitter @dustman_aapc.

No Responses to “Reporting Digital Breast Tomosynthesis Mammography in 2015”

  1. rebecca cranford says:

    I have several insurance companies that are not paying for the 77063 cpt code. we are billing it with the g0202,77052. it is saying it is not medical necessity. can you give me any help on this? Is it worth appealing.

  2. Susan Hamilton says:

    My insurance just denied paying for 77063 because it is not medically necessary and I will appeal my claim! Any tips would be greatly appreciated!

  3. Deborah Shull says:

    My insurance just denied code 77063 stating that “Tricare does not cover this experimental service.” Since when is reading a mammogram digital image an experiment? Our local hospital’s mammography department does only 3-D images and states that all the other area facilities are doing the same, because they’ve been proven to be superior to the old 2-D imagery. I requested a 2-D image be done because I ran into this problem last year too. Well, they no longer have any 2-D imagery equipment! Therefore, I’m being billed for a preventive screening image reading that should be included with preventive medical care and handled by insurance companies.
    It appears that I will end up in the same circumstances that a cousin of mine did several years ago because her insurance would not pay, fully or partially, for readings of preventive screenings for cancer. The insurance managed to find a way not to have to pay, and forced my cousin to pay outrageous costs out of pocket. She quit having any preventive screenings done. When she was finally in so much pain that her sister sent her to the ER, she discovered that the PAP screening she should have had, but could not afford to get because her insurance refused to pay even a part of the cost, would have been nice to have done. She died of 4th stage ovarian cancer 3 days after entering the ER.

  4. Lori Zamora says:

    the doctor that did my digital mammography billed 77061, so unilateral I guess. I only had one side b/c I had a mass on the screening mammogram only on ONE side. thanks for the input!!
    The insurance EOB says —
    Provider name: Seiler,Stephen,J,MD
    Provider Tax Id: 756002868
    Date of service: 12/18/18 – 12/18/18
    Date processed: 12/31/2018
    Procedure code: 77061
    You Pay: $93.00
    Why is the “Amount not payable”?
    $ 93.00 – Charge(s) Denied. This Service Is Excluded By Your Health Plan. Refer To General Exclusions In Your Benefit Booklet.